I Hit A Bone!!

loquacity · Nov 23, 2006

as an instructor she should know (as i do as a fellow student) that even if she is able to quickly dart it in to only halfway, that a student realtivley new to injections probably doesnt have the dexterity, motr control, muscle memory to do such a deed, and if she wanted you to practice on a arm going only half in, you should practice on a beefy arm...not the skin and bones arm.

~Loquacity

TazziRN, RN · Nov 23, 2006

And third, who teaches a new nurse to insert a needle halfway when the proper way is to jab it in like a dart. Duh.:trout:

*raising hand*

Me. I was taught the darting method too, and those are the times I hit bones the most. Since then I've darted just hard enough to get past the dermal layer, from just above the skin, then pushed in gently. Haven't hit one since and pts have told me my injections are less painful than others because other nurses make them feel like dart boards. We have nursing students during the school year and when I observe them giving IMs I tell them, "I know you have to do it this way because of school, but this is how I do it."

yadda_yadda_yadda, LPN, LVN · Nov 23, 2006

:icon_hug:

Been there..done that, too.--and you can't help but feel terrible, but we don't have 'x-ray eyes'. If the needle was intact, just take a deep breath & move forward.

jill48, ASN, RN · Nov 23, 2006

*raising hand*
Me. I was taught the darting method too, and those are the times I hit bones the most. Since then I've darted just hard enough to get past the dermal layer, from just above the skin, then pushed in gently. Haven't hit one since and pts have told me my injections are less painful than others because other nurses make them feel like dart boards. We have nursing students during the school year and when I observe them giving IMs I tell them, "I know you have to do it this way because of school, but this is how I do it."

I'm sorry but that is just insane. Why would you dart it in til just past the dermis and then push it in gently? And just exactly how do you know when you have passed the dermal layer? The proper way to give an injection is to dart it in, there is no reason whatsoever to slow it down halfway. If there is any chance you can hit bone, then your needle is just too long. I don't understand why you would do this. My injections are so fast that my patients don't feel them half the time; after I do it, they say, "Ok, when are you going to do it?" I just did.

zenman · Nov 23, 2006

That's easy. First of all it should have been given in an area with more muscle. Second, she should have used a shorter needle. And third, who teaches a new nurse to insert a needle halfway when the proper way is to jab it in like a dart. Duh.:trout:

Let me make my point, now pun intended. I do not "dart" as you do not have as much control and are more likely to "impact" bone. I quickly insert the needle so I have better control and can follow the patient if they move. You can't do that if they happen to move when you "commit" to your "dart." I have big hands so I insert, aspirate (if appropriate) and handle the plunger all with one hand. I learned this a long time ago when working a Level I trauma center. It is ok to insert a needle halfway as many needle procedures are done this way (lumbar puncture for ex.) You do not have to insert to the hub. In the real world and if I was 100 yards away from getting a shorter needle, I'd save my time and insert halfway. But hopefully, one has already assessed the patient and can select the correct needle size and select the appropriate site. Most of us have hit bone at some point. Fortunately, due to my technique there is less of a chance of the needle breaking off...in fact almost none. If you do break a needle off, the physician will make the decision what to do. If a nurse broke a needle off in me as the other posters have described, I wouldn't worry about it. It can just join the other metal in my body! It most likely will work itself out and further cutting and probing is not necessary and just increases pain and chances of infection. Or just take me to the MRI and "suck" that thing out of me.

Would you like a "duh" and a trout,lol?

ns lpn · Nov 23, 2006

i've not hit bone yet, hope not too. it must have startled you. as far as feeling like your not doing a good job, i think your instructor should have guided you better, a different site or shorter needle would have been much better guidance to you. also, i've had clients who have very thick skin and some force is actually needed to get through it, can't imagine trying to go 1/2 way with them.

i noticed a few people have done the same, was wondering how common it is to hit bone? i only do the occassional im's usually use the deltoid and have elderly clients , so it's always a concern i have when giving their injections. have any of you had any major complications b/c of this? i would like to use other sites but because the deltoid is usually the easiest to access and i find the easiest to landmark it is the one i typically choose if able.

jill48, ASN, RN · Nov 23, 2006

Let me make my point, now pun intended. I do not "dart" as you do not have as much control and are more likely to "impact" bone. I quickly insert the needle so I have better control and can follow the patient if they move. You can't do that if they happen to move when you "commit" to your "dart." I have big hands so I insert, aspirate (if appropriate) and handle the plunger all with one hand. I learned this a long time ago when working a Level I trauma center. It is ok to insert a needle halfway as many needle procedures are done this way (lumbar puncture for ex.) You do not have to insert to the hub. In the real world and if I was 100 yards away from getting a shorter needle, I'd save my time and insert halfway. But hopefully, one has already assessed the patient and can select the correct needle size and select the appropriate site. Most of us have hit bone at some point. Fortunately, due to my technique there is less of a chance of the needle breaking off...in fact almost none. If you do break a needle off, the physician will make the decision what to do. If a nurse broke a needle off in me as the other posters have described, I wouldn't worry about it. It can just join the other metal in my body! It most likely will work itself out and further cutting and probing is not necessary and just increases pain and chances of infection. Or just take me to the MRI and "suck" that thing out of me.
Would you like a "duh" and a trout,lol?

Actually, comparing a spinal tap too an intramuscular injection is like comparing apples and oranges (or duh's and trouts in your case); just because there is a needle involved doesn't make it even close to the same procedure - that is like comparing your IM to starting an IV. And darting an injection does not mean you are using your whole arm to force it in the patients body, you make it sound violent. Darting is a wrist motion only. I have complete control over my wrist motion and therefore my dart. Your way sounds painful. Now, here is your Duh, and here is your trout.:trout:

ICRN2008, BSN, RN · Nov 23, 2006

That happened to my sister once! She said that she almost fainted, because she's pretty squeamish (good thing she's a pharmacist!).

My instructor told us at a recent flu clinic that sometimes these things happen when you are dealing with the elderly. Unfortunately you do not always have choice of needle sizes. We only had 7/8 inch needles, and I am sure that we injected SQ on some of our larger clients.

TazziRN, RN · Nov 23, 2006

I'm sorry but that is just insane. Why would you dart it in til just past the dermis and then push it in gently? And just exactly how do you know when you have passed the dermal layer? The proper way to give an injection is to dart it in, there is no reason whatsoever to slow it down halfway. If there is any chance you can hit bone, then your needle is just too long. I don't understand why you would do this. My injections are so fast that my patients don't feel them half the time; after I do it, they say, "Ok, when are you going to do it?" I just did.

You missed the part where I said "from just above the skin". I don't dart it from across the room. I slow it down halfway because I've hit bone quite a few times by throwing darts. In darting the way you describe it you must have a certain needle length because you will drive it in almost to the hub, if not all the way. My way you don't have to. I have never hit bone using this method and my pts tell me they barely feel the needle. I also am not the only one who does this, quite a few nurses I know do, so my method can't be that insane. And who are you to say the method is not proper?

TazziRN, RN · Nov 23, 2006

Zenman, thank you!!!

jill48, ASN, RN · Nov 23, 2006

You missed the part where I said "from just above the skin". I don't dart it from across the room. I slow it down halfway because I've hit bone quite a few times by throwing darts. In darting the way you describe it you must have a certain needle length because you will drive it in almost to the hub, if not all the way. My way you don't have to. I have never hit bone using this method and my pts tell me they barely feel the needle. I also am not the only one who does this, quite a few nurses I know do, so my method can't be that insane. And who are you to say the method is not proper?

I cannot locate my Potter and Perry at the moment, but if you find a textbook it will tell you that you insert the needle all the way and in one smooth motion, not half way, and not fast through the epidermis and dermis then slowwwwly into the subq. THAT is "who I am" to say the other method is not proper. It may work for you, but that is not textbook. If you know of a textbook that says otherwise, let me know and I will surely read it and change my opinion. This is just what I was taught and it works well for me. If your way works well for you, so be it.

breakin_moon · Nov 23, 2006

Amen!